Morbid obesity can exact huge costs

Peninsula health providers confront the complexities of care

The three most common procedures are the gastric bypass, the sleeve gastrectomy and the adjustable gastric band, or "lap-band" surgery. The hardest thing for people is making the decision for surgery, said Salzberg. "They see it as a drastic step." However, he said, it now has wide acceptance, a change from a few years ago.

Currently, bariatric or weight-loss surgery for the morbidly obese is covered by Medicare and Medicaid, most government employee plans, most large group plans, and some plans that have bariatric riders. Under the "essential health benefits" proposed by the Virginia Health Reform Taskforce for the state's health exchange (which is currently on hold), bariatric surgery would also be mandated for individual and small-group plans. The taskforce estimated costs for this benefit between .75 percent and 1.5 percent.

Salzberg likens the costs of obesity for patients to "buying a new car every year" in medications, health care, food, and so forth. He describes the surgery as "liberating — they're not thinking about food all the time. It's a brand-new life."

Bariatric surgery works

Experts agree that it takes lots of pre- and post-counseling to make the surgery effective.

"When weight gets to be high enough, diet and exercise alone are almost universal failures. The amount of food they need is so little, the sensation of hunger is intolerable," said Salzberg.

With surgery, the rate of weight loss is typically 85 percent of excess body weight over one to two years. "If someone weighs 350 pounds, they're going to lose 175 pounds comfortably," he said.

With that loss, come cures for chronic conditions. "Half of diabetics no longer need insulin; people come off high blood pressure medication after three months and cholesterol medication after six months. It doubles or triples the efficacy of orthopedic surgery. We're truly finding cures for long-term chronic problems," said Salzberg.

Clark is more cautious, stating that the surgery itself is not the cure. "It's a tool. They still have to do the right things. The surgery is just one hour out of their life. Education and compliance are key."